[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[S. 1551 Reported in Senate (RS)]






                                                       Calendar No. 549
110th CONGRESS
  1st Session
                                S. 1551

To amend the Public Health Service Act with respect to making progress 
  toward the goal of eliminating tuberculosis, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              June 5, 2007

Mr. Brown (for himself, Mrs. Hutchison, Mr. Kennedy, Mrs. Clinton, Mrs. 
 Murray, Mrs. Feinstein, Mr. Sanders, Mr. Bingaman, Mr. Menendez, Mr. 
Harkin, Mrs. Boxer, Ms. Landrieu, Ms. Cantwell, Ms. Murkowski, and Mr. 
  Lautenberg) introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

                           December 18, 2007

               Reported by Mr. Kennedy, with an amendment
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]

_______________________________________________________________________

                                 A BILL


 
To amend the Public Health Service Act with respect to making progress 
  toward the goal of eliminating tuberculosis, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

<DELETED>SECTION 1. SHORT TITLE; TABLE OF CONTENTS.</DELETED>

<DELETED>    (a) Short Title.--This Act may be cited as the 
``Comprehensive Tuberculosis Elimination Act of 2007''.</DELETED>
<DELETED>    (b) Table of Contents.--The table of contents for this Act 
is as follows:</DELETED>

<DELETED>Sec. 1. Short title; table of contents.
<DELETED>Sec. 2. Findings.
      <DELETED>TITLE I--CENTERS FOR DISEASE CONTROL AND PREVENTION

 <DELETED>Subtitle A--National Program for Elimination of Tuberculosis

<DELETED>Sec. 101. National program.
             <DELETED>Subtitle B--Interagency Collaboration

<DELETED>Sec. 111. Advisory council for elimination of tuberculosis.
      <DELETED>Subtitle C--New Tools for Tuberculosis Elimination

<DELETED>Sec. 121. New tools.
         <DELETED>Subtitle D--Authorizations of Appropriations

<DELETED>Sec. 131. Authorizations of appropriations.
            <DELETED>TITLE II--NATIONAL INSTITUTES OF HEALTH

<DELETED>Sec. 201. Research and development concerning tuberculosis.
<DELETED>Sec. 202. Activities of National institute of Allergy and 
                            Infectious Diseases.
<DELETED>Sec. 203. John E. Fogarty International Center for Advanced 
                            Study in the Health Sciences.
<DELETED>Sec. 204. Loan repayment programs regarding research on 
                            tuberculosis.
<DELETED>Sec. 205. Authorization of appropriations.

<DELETED>SEC. 2. FINDINGS.</DELETED>

<DELETED>    The Congress finds as follows:</DELETED>
        <DELETED>    (1) Each year approximately 9,000,000 people 
        become ill with active tuberculosis ( referred to in this 
        section as ``TB''), and it is estimated that 1,600,000 of those 
        people die, a result of critical underinvestment in quality TB 
        control and the research and development of new TB drugs, 
        diagnostics and a vaccine, as well as the comorbid relationship 
        between TB and HIV/AIDS. Such levels of morbidity and mortality 
        are complicated by the disease having the ability to develop 
        resistance to treatments and to travel easily across 
        borders.</DELETED>
        <DELETED>    (2) In 2006, there were 13,767 cases of active TB 
        reported in the United States. The average annual decline in 
        the national TB rate slowed from 7.3 percent per year in the 
        period of 1993 to 2000 to 3.8 percent per year in the period of 
        2000 to 2006.</DELETED>
        <DELETED>    (3) In addition to those with active TB, an 
        estimated 10,000,000 to 15,000,000 people in the United States 
        have latent TB infection.</DELETED>
        <DELETED>    (4) The increasing occurrence of multidrug 
        resistant (``MDR'') TB, including extensively drug resistant 
        (``XDR'') TB--which is resistant to at least almost all drugs 
        used to treat TB, including the two recommended first-line 
        drugs and the recommended second-line medications, raises 
        concerns of a future epidemic of virtually untreatable 
        TB.</DELETED>
        <DELETED>    (5) To prevent the spread of extensively drug 
        resistant TB, the immediate strengthening of TB control systems 
        must be a priority. This includes improved case detection, 
        strengthened laboratory capacity, rapid implementation of 
        infection control measures, enhanced treatment programs, and 
        immediate support to existing public sector 
        infrastructure.</DELETED>
        <DELETED>    (6) The Centers for Disease Control and Prevention 
        is increasingly relied upon globally for its expertise and 
        technical assistance in global tuberculosis preparedness and 
        outbreak response capacity to identify and investigate 
        outbreaks of multidrug resistant and extensively drug resistant 
        TB.</DELETED>
        <DELETED>    (7) New tools are needed to more effectively 
        prevent, diagnose, and treat TB. The standard method of 
        diagnosing TB is over 100 years old, and fails to adequately 
        detect TB, especially in children and those co-infected with 
        HIV/AIDS. The newest class of anti-TB drug is over 40 years 
        old, while rates of multidrug resistant TB are rising globally. 
        The existing vaccine confers no protection to adolescents and 
        adults, protecting only against severe forms of TB in infants 
        and young children.</DELETED>

 <DELETED>TITLE I--CENTERS FOR DISEASE CONTROL AND PREVENTION</DELETED>

       <DELETED>Subtitle A--National Program for Elimination of 
                         Tuberculosis</DELETED>

<DELETED>SEC. 101. NATIONAL PROGRAM.</DELETED>

<DELETED>    Section 317E of the Public Health Service Act (42 U.S.C. 
247b-6) is amended--</DELETED>
        <DELETED>    (1) by striking the heading for the section and 
        inserting the following: ``national program for elimination of 
        tuberculosis''; and</DELETED>
        <DELETED>    (2) by amending subsection (b) to read as 
        follows:</DELETED>
<DELETED>    ``(b) Research and Development; Demonstration Projects; 
Education and Training.--With respect to the prevention, treatment, 
control, and elimination of tuberculosis, the Secretary may, directly 
or through grants to public or nonprofit private entities, carry out 
the following:</DELETED>
        <DELETED>    ``(1) Research, with priority given to research 
        and development concerning--</DELETED>
                <DELETED>    ``(A) clinical trials to evaluate the 
                safety and effectiveness of new drugs, diagnostics, and 
                vaccines for latent tuberculosis infection and active 
                tuberculosis, including drug-resistant tuberculosis, 
                that are suitable for use by patients with HIV/
                AIDS;</DELETED>
                <DELETED>    ``(B) epidemiological studies of 
                populations at risk for tuberculosis; and</DELETED>
                <DELETED>    ``(C) field studies to evaluate the 
                effectiveness of new drugs, diagnostics, and vaccines, 
                to assess the incidence and prevalence of multidrug 
                resistant and extensively drug resistant strains of 
                tuberculosis.</DELETED>
        <DELETED>    ``(2) Demonstration projects for--</DELETED>
                <DELETED>    ``(A) the development of regional 
                capabilities to prevent, control and eliminate 
                tuberculosis and prevent mutidrug resistant and 
                extensively drug resistant strains of 
                tuberculosis;</DELETED>
                <DELETED>    ``(B) the intensification of efforts--
                </DELETED>
                        <DELETED>    ``(i) to prevent, detect, and 
                        treat tuberculosis among African Americans, 
                        Hispanic Americans, Asian Americans, and other 
                        United States-born populations with documented 
                        health disparities; and</DELETED>
                        <DELETED>    ``(ii) to reduce or eliminate 
                        racial disparities in the incidence of 
                        tuberculosis in these populations;</DELETED>
                <DELETED>    ``(C) the intensification of efforts to 
                control tuberculosis along the United States-Mexico 
                border and among United States-Mexico binational 
                populations;</DELETED>
                <DELETED>    ``(D) the intensification of efforts to 
                prevent, detect, and treat tuberculosis among foreign-
                born persons who are in the United States;</DELETED>
                <DELETED>    ``(E) providing guidance to Immigration 
                and Customs Enforcement in developing risk-based 
                screening procedures based on current epidemiological 
                data;</DELETED>
                <DELETED>    ``(F) the intensification of efforts to 
                increase targeted testing and treatment of latent 
                tuberculosis infection and drug-resistant tuberculosis; 
                and</DELETED>
                <DELETED>    ``(G) the intensification of efforts to 
                prevent, detect, and treat tuberculosis among other 
                high risk populations and settings, including among 
                children and adolescents, homeless persons, detainees 
                and prisoners, HIV-infected persons, and within health 
                care settings.</DELETED>
        <DELETED>    ``(3) A public information and education program 
        to include components that raise awareness regarding 
        tuberculosis among the general population as well as those that 
        target populations documented as having high risk for 
        tuberculosis.</DELETED>
        <DELETED>    ``(4) Education, training and clinical skills 
        improvement activities for health professionals, including 
        allied health personnel and emergency response 
        employees.</DELETED>
        <DELETED>    ``(5) Provide support for the Tuberculosis Trials 
        Consortium, the Tuberculosis Epidemiologic Studies Consortium, 
        the National Laboratory Training Network, and Regional Training 
        and Medical Consultation Centers to carry out activities under 
        paragraphs (1) through (4).</DELETED>
        <DELETED>    ``(6) Collaboration with international 
        organizations and foreign countries in intensifying efforts to 
        prevent, treat, control, and eliminate tuberculosis, including 
        efforts that address risks associated with international 
        travel.</DELETED>
        <DELETED>    ``(7) Develop, enhance, and expand information 
        technologies that support tuberculosis control, including 
        surveillance and database management systems with cross-
        jurisdictional capabilities.''.</DELETED>

        <DELETED>Subtitle B--Interagency Collaboration</DELETED>

<DELETED>SEC. 111. ADVISORY COUNCIL FOR ELIMINATION OF 
              TUBERCULOSIS.</DELETED>

<DELETED>    (a) In General.--Section 317E(f) of the Public Health 
Service Act (42 U.S.C. 247b-6(f)) is amended--</DELETED>
        <DELETED>    (1) by redesignating paragraph (5) as paragraph 
        (6); and</DELETED>
        <DELETED>    (2) by striking paragraphs (2) through (4), and 
        inserting the following:</DELETED>
        <DELETED>    ``(2) Duties.--The Council shall provide advice 
        and recommendations regarding the elimination of tuberculosis 
        to the Secretary, the Assistant Secretary for Health, and the 
        Director of the Centers for Disease Control and Prevention. In 
        addition, the Council shall, with respect to eliminating such 
        disease, provide to the Secretary and other appropriate Federal 
        officials advice on--</DELETED>
                <DELETED>    ``(A) coordinating the activities of the 
                Public Health Service and other Federal agencies that 
                relate to the disease, including activities under 
                subsection (b);</DELETED>
                <DELETED>    ``(B) responding rapidly and effectively 
                to cases of extensively drug resistant strains of 
                tuberculosis; and</DELETED>
                <DELETED>    ``(C) efficiently utilizing the Federal 
                resources involved.</DELETED>
        <DELETED>    ``(3) Comprehensive plan.--</DELETED>
                <DELETED>    ``(A) In general.--In carrying out 
                paragraph (2), the Council shall make recommendations 
                on the development, revision, and implementation of a 
                comprehensive plan to eliminate tuberculosis in the 
                United States.</DELETED>
                <DELETED>    ``(B) Consultation.--In carrying out 
                subparagraph (A), the Council shall consult with public 
                and private entities, including--</DELETED>
                        <DELETED>    ``(i) individuals who are 
                        scientists, physicians, laboratorians, and 
                        other health professionals, who are not 
                        officers or employees of the Federal Government 
                        and who represent the disciplines relevant to 
                        tuberculosis elimination;</DELETED>
                        <DELETED>    ``(ii) members of public-private 
                        partnerships established to address the 
                        elimination of tuberculosis;</DELETED>
                        <DELETED>    ``(iii) members of national and 
                        international nongovernmental organizations 
                        established to address tuberculosis 
                        elimination; and</DELETED>
                        <DELETED>    ``(iv) members from the general 
                        public who are knowledgeable with respect to 
                        tuberculosis elimination including individuals 
                        who have or have had tuberculosis.</DELETED>
                <DELETED>    ``(C) Certain components of plan.--In 
                carrying out subparagraph (A), the Council shall--
                </DELETED>
                        <DELETED>    ``(i) consider the recommendations 
                        of the Institute of Medicine regarding the 
                        elimination of tuberculosis;</DELETED>
                        <DELETED>    ``(ii) consider recommendations 
                        for the involvement of the United States in 
                        continuing global and cross-border tuberculosis 
                        control activities in countries where a high 
                        incidence of tuberculosis directly affects the 
                        United States such as Mexico; and</DELETED>
                        <DELETED>    ``(iii) review the extent to which 
                        progress has been made toward eliminating 
                        tuberculosis.</DELETED>
        <DELETED>    ``(4) Annual report.--The Council shall annually 
        submit to Congress and the Secretary a report on the activities 
        carried under this section, other than subsection (g). Each 
        such report shall include the opinion of the Council on the 
        extent to which its recommendations regarding the elimination 
        of tuberculosis have been implemented, including with respect 
        to--</DELETED>
                <DELETED>    ``(A) activities under subsection (b); 
                and</DELETED>
                <DELETED>    ``(B) the national plan referred to in 
                paragraph (3).</DELETED>
        <DELETED>    ``(5) Composition.--The Council shall be composed 
        of--</DELETED>
                <DELETED>    ``(A) representatives from the Centers for 
                Disease Control and Prevention, the National Institutes 
                of Health, the United States Agency for International 
                Development, the Agency for Healthcare Research and 
                Quality, the Health Resources and Services 
                Administration, the United States-Mexico Border Health 
                Commission, and other Federal departments and agencies 
                that carry out significant activities related to 
                tuberculosis;</DELETED>
                <DELETED>    ``(B) State and local tuberculosis control 
                and public health officials;</DELETED>
                <DELETED>    ``(C) individuals who are scientists, 
                physicians, laboratorians, and other health 
                professionals who represent disciplines relevant to 
                tuberculosis elimination;</DELETED>
                <DELETED>    ``(D) members of national and 
                international nongovernmental organizations established 
                to address the elimination of tuberculosis; 
                and</DELETED>
                <DELETED>    ``(E) members from the general public who 
                are knowledgeable with respect to the elimination of 
                tuberculosis, including individuals who have or have 
                had tuberculosis.''.</DELETED>
<DELETED>    (b) Rule of Construction Regarding Current Membership.--
With respect to the advisory council under section 317E(f) of the 
Public Health Service Act, the amendments made by subsection (a) may 
not be construed as terminating the membership on such council of any 
individual serving as such a member as of the day before the date of 
the enactment of this Act.</DELETED>

 <DELETED>Subtitle C--New Tools for Tuberculosis Elimination</DELETED>

<DELETED>SEC. 121. NEW TOOLS.</DELETED>

<DELETED>    Section 317E of the Public Health Service Act (42 U.S.C. 
247b-6) is amended--</DELETED>
        <DELETED>    (1) by redesignating subsection (g) as subsection 
        (h); and</DELETED>
        <DELETED>    (2) by inserting after subsection (f) the 
        following subsection:</DELETED>
<DELETED>    ``(g) New Tools for Elimination of Tuberculosis.--
</DELETED>
        <DELETED>    ``(1) Research and development on drugs, 
        diagnostics, vaccines, and public health interventions.--The 
        Secretary, acting through the Director of the Centers for 
        Disease Control and Prevention, shall expand, intensify, and 
        coordinate research and development and related activities of 
        such Centers to develop new tools for the elimination of 
        tuberculosis, including drugs, diagnostics, vaccines, and 
        public health interventions, such as directly observed therapy 
        and non-pharmaceutical intervention.</DELETED>
        <DELETED>    ``(2) Federal tuberculosis task force.--</DELETED>
                <DELETED>    ``(A) Duties.--The Federal Tuberculosis 
                Task Force (established in December 2001 as part of the 
                Centers for Disease Control and Prevention) (in this 
                subsection referred to as the `Task Force') shall 
                provide to the Secretary and other appropriate Federal 
                officials advice on the implementation of paragraph 
                (1), including advice regarding the efficient 
                utilization of the Federal resources 
                involved.</DELETED>
                <DELETED>    ``(B) Comprehensive plan for new tools 
                development.--In carrying out paragraph (1), the Task 
                Force shall make recommendations on the development of 
                a comprehensive plan for the creation of new tools for 
                the elimination of tuberculosis, including drugs, 
                diagnostics, and vaccines.</DELETED>
                <DELETED>    ``(C) Consultation.--In developing the 
                comprehensive plan under paragraph (1), the Task Force 
                shall consult with--</DELETED>
                        <DELETED>    ``(i) scientists, physicians, 
                        laboratorians, and other health professionals 
                        and who represent the specialties and 
                        disciplines relevant to the research under 
                        consideration;</DELETED>
                        <DELETED>    ``(ii) members from public-private 
                        partnerships or foundations (or both) engaged 
                        in research relevant to research under 
                        consideration;</DELETED>
                        <DELETED>    ``(iii) members of national and 
                        international nongovernmental organizations 
                        established to address tuberculosis 
                        elimination;</DELETED>
                        <DELETED>    ``(iv) members from the general 
                        public who are knowledgeable with respect to 
                        tuberculosis, including individuals who have or 
                        have had tuberculosis; and</DELETED>
                        <DELETED>    ``(v) scientists, physicians, 
                        laboratorians, and other health professionals 
                        who reside in a foreign country with a 
                        substantial incidence or prevalence of 
                        tuberculosis, and who represent the specialties 
                        and disciplines relevant to the research under 
                        consideration.</DELETED>
        <DELETED>    ``(3) Grants and contracts.--The Secretary shall 
        carry out paragraph (1) directly and through awards of grants, 
        cooperative agreements, and contracts to public and private 
        entities, including--</DELETED>
                <DELETED>    ``(A) public-private 
                partnerships;</DELETED>
                <DELETED>    ``(B) academic institutions, including 
                institutions of higher education;</DELETED>
                <DELETED>    ``(C) research institutions; and</DELETED>
                <DELETED>    ``(D) the Tuberculosis Trials Consortium 
                and the Tuberculosis Epidemiologic Studies 
                Consortium.''.</DELETED>

    <DELETED>Subtitle D--Authorizations of Appropriations</DELETED>

<DELETED>SEC. 131. AUTHORIZATIONS OF APPROPRIATIONS.</DELETED>

<DELETED>    Section 317E of the Public Health Service Act, as amended 
by section 121(1) of this Act, is amended by striking subsection (h) 
and inserting the following:</DELETED>
<DELETED>    ``(h) Authorization of Appropriations.--</DELETED>
        <DELETED>    ``(1) General program.--</DELETED>
                <DELETED>    ``(A) In general.--For the purpose of 
                carrying out this section, other than subsections (b) 
                and (g), there are authorized to be appropriated 
                $300,000,000 for fiscal year 2008, and such sums as may 
                be necessary for each of the fiscal years 2009 through 
                2012.</DELETED>
                <DELETED>    ``(B) Reservation for emergency grants.--
                Of the amounts appropriated under subparagraph (A) for 
                a fiscal year, the Secretary may reserve not more than 
                25 percent for emergency grants under subsection (a) 
                for any State, political subdivision of a States, or 
                other public entity in which there is, relative to 
                other areas, a substantial number of cases of 
                tuberculosis, multidrug resistant tuberculosis, or 
                extensively drug resistant tuberculosis or a 
                substantial rate of increase in such cases.</DELETED>
                <DELETED>    ``(C) Research, demonstration projects, 
                education, and training.--For the purpose of carrying 
                out subsection (b), there are authorized to be 
                appropriated such sums as may be necessary for each of 
                fiscal years 2008 through 2012.</DELETED>
                <DELETED>    ``(D) Priority.--In allocating amounts 
                appropriated under subparagraph (A) and not reserved 
                under subparagraph (B), the Secretary shall give 
                priority to allocating such amounts for grants under 
                subsection (a).</DELETED>
                <DELETED>    ``(E) Allocation of funds.--</DELETED>
                        <DELETED>    ``(i) Requirement of formula.--Of 
                        the amounts appropriated under subparagraph 
                        (A), not reserved under subparagraph (B), and 
                        allocated by the Secretary for grants under 
                        subsection (a), the Secretary shall distribute 
                        such amounts to grantees under subsection (a) 
                        on the basis of a formula.</DELETED>
                        <DELETED>    ``(ii) Relevant factors.--The 
                        formula developed by the Secretary under clause 
                        (i) shall take into account the level of 
                        tuberculosis morbidity in the respective 
                        geographic area and may consider other factors 
                        relevant to tuberculosis in such 
                        area.</DELETED>
                        <DELETED>    ``(iii) No change to formula 
                        required.--This subparagraph does not require 
                        the Secretary to modify the formula that was 
                        used by the Secretary to distribute funds to 
                        grantees under subsection (a) for fiscal year 
                        2007.</DELETED>
        <DELETED>    ``(2) New tools.--</DELETED>
                <DELETED>    ``(A) In general.--For the purpose of 
                carrying out subsection (g), there are authorized to be 
                appropriated $100,000,000 for fiscal year 2008, and 
                such sums as may be necessary for each of the fiscal 
                years 2009 through 2012.</DELETED>
                <DELETED>    ``(B) Limitation.--The authorization of 
                appropriations established in subparagraph (A) for a 
                fiscal year is effective only if the amount 
                appropriated under paragraph (1) for such year equals 
                or exceeds the amount appropriated to carry out this 
                section for fiscal year 2007.''.</DELETED>

       <DELETED>TITLE II--NATIONAL INSTITUTES OF HEALTH</DELETED>

<DELETED>SEC. 201. RESEARCH AND DEVELOPMENT CONCERNING 
              TUBERCULOSIS.</DELETED>

<DELETED>    (a) In General.--Subpart 2 of part C of title IV of the 
Public Health Service Act (42 U.S.C. 285b et seq.) is amended by 
inserting after section 424B the following section:</DELETED>

<DELETED>``SEC. 424C. TUBERCULOSIS.</DELETED>

<DELETED>    ``(a) In General.--The Director of the National Institutes 
of Health shall expand, intensify, and coordinate research and 
development and related activities of the Institute with respect to 
tuberculosis, including activities toward the goal of eliminating such 
disease.</DELETED>
<DELETED>    ``(b) Certain Activities.--Activities under subsection (a) 
shall include--</DELETED>
        <DELETED>    ``(1) enhancing basic and clinical research on 
        tuberculosis, including drug resistant tuberculosis; 
        and</DELETED>
        <DELETED>    ``(2) expanding research on the relationship 
        between such disease and the human immunodeficiency 
        virus.''.</DELETED>
<DELETED>    (b) Research Education.--Part A of title IV of the Public 
Health Service Act (42 U.S.C. 281 et seq.) is amended by adding at the 
end the following:</DELETED>

<DELETED>``SEC. 404I. TUBERCULOSIS ACADEMIC AWARDS.</DELETED>

<DELETED>    ``(a) Tuberculosis Academic Awards.--The Director of the 
National Institutes of Health may provide awards to faculty of schools 
of medicine, osteopathic medicine, nursing, public health, or related 
fields to assist such faculty in developing high quality curricula in 
such schools designed to significantly increase the opportunities for 
interested individuals, including students of the school and practicing 
physicians and nurses, to learn the principles and practices of 
preventing, managing, and controlling tuberculosis.</DELETED>
<DELETED>    ``(b) Tuberculosis/pulmonary Infection Awards.--The 
Director of the National Institutes of Health may provide awards to 
support the career development of clinically trained professionals who 
are committed to research regarding pulmonary infections and 
tuberculosis by providing for supervised study and 
research.''.</DELETED>

<DELETED>SEC. 202. ACTIVITIES OF NATIONAL INSTITUTE OF ALLERGY AND 
              INFECTIOUS DISEASES.</DELETED>

<DELETED>    Section 447A of the Public Health Service Act (42 U.S.C. 
285f-2) is amended--</DELETED>
        <DELETED>    (1) by striking ``In carrying out section 446'' 
        and inserting ``(a) In carrying out section 446''; 
        and</DELETED>
        <DELETED>    (2) by inserting at the end the 
        following:</DELETED>
<DELETED>    ``(b) Activities under subsection (a) shall include 
activities to develop a tuberculosis vaccine. Such activities shall be 
carried out in accordance with the blueprint for tuberculosis vaccine 
development described in the report prepared pursuant to the workshop 
convened in March 1998 by the Advisory Council for Elimination of 
Tuberculosis, the Director of the National Vaccine Program, and the 
Director of the Institute.''.</DELETED>

<DELETED>SEC. 203. JOHN E. FOGARTY INTERNATIONAL CENTER FOR ADVANCED 
              STUDY IN THE HEALTH SCIENCES.</DELETED>

<DELETED>    Section 482 of the Public Health Service Act (42 U.S.C. 
287b) is amended--</DELETED>
        <DELETED>    (1) by inserting ``(a) In General.--'' before 
        ``The general purpose'';</DELETED>
        <DELETED>    (2) in subsection (a) (as so designated), by 
        inserting after ``Health Sciences'' the following: ``(in this 
        subpart referred to as the `Center')''; and</DELETED>
        <DELETED>    (3) by adding at the end the following 
        subsection:</DELETED>
<DELETED>    ``(b) Tuberculosis.--</DELETED>
        <DELETED>    ``(1) In general.--In carrying out subsection (a) 
        with respect to tuberculosis, the Center shall expand, 
        intensify, and coordinate international activities of the 
        Center for research and training.</DELETED>
        <DELETED>    ``(2) International training program.--In carrying 
        out paragraph (1), the Center shall carry out an international 
        training program regarding tuberculosis. Such program shall be 
        modeled after the international training program carried out by 
        the Center with respect to the human immunodeficiency 
        virus.''.</DELETED>

<DELETED>SEC. 204. LOAN REPAYMENT PROGRAMS REGARDING RESEARCH ON 
              TUBERCULOSIS.</DELETED>

<DELETED>    Part G of title IV of the Public Health Service Act (42 
U.S.C. 288 et seq.) is amended--</DELETED>
        <DELETED>    (1) by redesignating the second section 487F as 
        section 487G; and</DELETED>
        <DELETED>    (2) by inserting after section 487G (as so 
        redesignated) the following section:</DELETED>

<DELETED>``loan repayments regarding research on tuberculosis</DELETED>

<DELETED>    ``Sec. 487H.  In carrying out sections 487C, 487E, and 
487F, the Secretary shall seek to ensure that, for fiscal year 2008 and 
subsequent fiscal years, a portion of amounts appropriated to carry out 
such sections is reserved for the purpose of entering into contracts 
under which (in accordance with the section involved) individuals will 
conduct research on tuberculosis. The Secretary shall have sole 
discretion for the administration of activities under this 
section.''.</DELETED>

<DELETED>SEC. 205. AUTHORIZATION OF APPROPRIATIONS.</DELETED>

<DELETED>    For the purpose of carrying out this title and the 
amendments made by this title, there are authorized to be appropriated 
such sums as may be necessary. Such authorization of appropriations 
shall be in addition to the authorization of appropriations established 
by section 402A(a) of the Public Health Service Act and any other 
authorization of appropriations available for such purpose.</DELETED>

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Comprehensive 
Tuberculosis Elimination Act of 2007''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.

 TITLE I--DEPARTMENT OF HEALTH AND HUMAN SERVICES IN COORDINATION WITH 
 THE CENTERS FOR DISEASE CONTROL AND PREVENTION AND OTHER APPROPRIATE 
                                AGENCIES

      Subtitle A--National Strategy for Combating and Eliminating 
                              Tuberculosis

Sec. 101. National strategy.

                 Subtitle B--Interagency Collaboration

Sec. 111. Advisory council for elimination of tuberculosis.

           Subtitle C--New Tools for Tuberculosis Elimination

Sec. 121. New tools.

          Subtitle D--Evaluation of Public Health Authorities

Sec. 131. Evaluation of public health authorities.

              Subtitle E--Authorization of Appropriations

Sec. 141. Authorizations of appropriations.

                TITLE II--NATIONAL INSTITUTES OF HEALTH

Sec. 201. Research and development concerning tuberculosis.

 TITLE I--DEPARTMENT OF HEALTH AND HUMAN SERVICES IN COORDINATION WITH 
 THE CENTERS FOR DISEASE CONTROL AND PREVENTION AND OTHER APPROPRIATE 
                                AGENCIES

      Subtitle A--National Strategy for Combating and Eliminating 
                              Tuberculosis

SEC. 101. NATIONAL STRATEGY.

    Section 317E of the Public Health Service Act (42 U.S.C. 247b-6) is 
amended--
            (1) by striking the heading for the section and inserting 
        the following: ``national strategy for combating and 
        eliminating tuberculosis'';
            (2) by amending subsection (b) to read as follows:
    ``(b) Research and Development; Demonstration Projects; Education 
and Training.--With respect to the prevention, treatment, control, and 
elimination of tuberculosis, the Secretary may, directly or through 
grants to public or nonprofit private entities, carry out the 
following:
            ``(1) Research, with priority given to research and 
        development concerning latent tuberculosis infection, strains 
        of tuberculosis resistant to drugs, and research concerning 
        cases of tuberculosis that affect certain populations at risk 
        for tuberculosis.
            ``(2) Demonstration projects for--
                    ``(A) the development of regional capabilities to 
                prevent, control and eliminate tuberculosis and prevent 
                multidrug resistant and extensively drug resistant 
                strains of tuberculosis;
                    ``(B) the intensification of efforts to reduce 
                health disparities in the incidence of tuberculosis;
                    ``(C) the intensification of efforts to control 
                tuberculosis along the United States-Mexico border and 
                among United States-Mexico binational populations, 
                including through expansion of the scope and number of 
                programs that--
                            ``(i) detect and treat binational cases of 
                        tuberculosis; and
                            ``(ii) treat high-risk cases of 
                        tuberculosis referred from Mexican health 
                        departments;
                    ``(D) the intensification of efforts to prevent, 
                detect, and treat tuberculosis among foreign-born 
                persons who are in the United States;
                    ``(E) the intensification of efforts to prevent, 
                detect, and treat tuberculosis among populations and 
                settings documented as having a high risk for 
                tuberculosis; and
                    ``(F) tuberculosis detection, control, and 
                prevention.
            ``(3) Public information and education activities.
            ``(4) Education, training, clinical skills improvement 
        activities, and workplace exposure prevention for health 
        professionals, including allied health personnel and emergency 
        response employees.
            ``(5) Support of Centers to carry out activities under 
        paragraphs (1) through (4).
            ``(6) Collaboration with international organizations and 
        foreign countries in carrying out such activities.
            ``(7) Develop, enhance, and expand information technologies 
        that support tuberculosis control including surveillance and 
        database management systems with cross-jurisdictional 
        capabilities, which shall conform to the standards and 
        implementation specifications for such information technologies 
        as recommended by the Secretary.''; and
            (3) in subsection (d), by adding at the end the following:
            ``(3) Determination of amount of nonfederal 
        contributions.--
                    ``(A) Priority.--In awarding grants under 
                subsection (a) or (b), the Secretary shall give highest 
                priority to an applicant that provides assurances that 
                the applicant will contribute non-Federal funds to 
                carry out activities under this section, which may be 
                provided directly or through donations from public or 
                private entities and may be in cash or in kind, 
                including equipment or services.
                    ``(B) Federal amounts not to be included as 
                contributions.--Amounts provided by the Federal 
                Government, or services assisted or subsidized to any 
                significant extent by the Federal Government, may not 
                be included in determining the amount of non-Federal 
                contributions as described in subparagraph (A).''.

                 Subtitle B--Interagency Collaboration

SEC. 111. ADVISORY COUNCIL FOR ELIMINATION OF TUBERCULOSIS.

    (a) In General.--Section 317E(f) of the Public Health Service Act 
(42 U.S.C. 247b-6(f)) is amended--
            (1) by redesignating paragraph (5) as paragraph (6); and
            (2) by striking paragraphs (2) through (4), and inserting 
        the following:
            ``(2) Duties.--The Council shall provide advice and 
        recommendations regarding the elimination of tuberculosis to 
        the Secretary. In addition, the Council shall, with respect to 
        eliminating such disease, provide to the Secretary and other 
        appropriate Federal officials advice on--
                    ``(A) coordinating the activities of the Department 
                of Health and Human Services and other Federal agencies 
                that relate to the disease, including activities under 
                subsection (b);
                    ``(B) responding rapidly and effectively to 
                emerging issues in tuberculosis; and
                    ``(C) efficiently utilizing the Federal resources 
                involved.
            ``(3) Comprehensive plan.--
                    ``(A) In general.--In carrying out paragraph (2), 
                the Council shall make or update recommendations on the 
                development, revision, and implementation of a 
                comprehensive plan to eliminate tuberculosis in the 
                United States.
                    ``(B) Consultation.--In carrying out subparagraph 
                (A), the Council may consult with appropriate public 
                and private entities, which may, subject to the 
                direction or discretion of the Secretary, include--
                            ``(i) individuals who are scientists, 
                        physicians, laboratorians, and other health 
                        professionals, who are not officers or 
                        employees of the Federal Government and who 
                        represent the disciplines relevant to 
                        tuberculosis elimination;
                            ``(ii) members of public-private 
                        partnerships or private entities established to 
                        address the elimination of tuberculosis;
                            ``(iii) members of national and 
                        international nongovernmental organizations 
                        whose purpose is to eliminate tuberculosis; and
                            ``(iv) members from the general public who 
                        are knowledgeable with respect to tuberculosis 
                        elimination including individuals who have or 
                        have had tuberculosis.
                    ``(C) Certain components of plan.--In carrying out 
                subparagraph (A), the Council shall, subject to the 
                direction or discretion of the Secretary--
                            ``(i) consider recommendations for the 
                        involvement of the United States in continuing 
                        global and cross-border tuberculosis control 
                        activities in countries where a high incidence 
                        of tuberculosis directly affects the United 
                        States; and
                            ``(ii) review the extent to which progress 
                        has been made toward eliminating tuberculosis.
            ``(4) Biennial report.--
                    ``(A) In general.--The Council shall submit a 
                biennial report to the Secretary, as determined 
                necessary by the Secretary, on the activities carried 
                under this section, other than subsection (g). Each 
                such report shall include the opinion of the Council on 
                the extent to which its recommendations regarding the 
                elimination of tuberculosis have been implemented, 
                including with respect to--
                            ``(i) activities under subsection (b); and
                            ``(ii) the national plan referred to in 
                        paragraph (3).
                    ``(B) Public.--The Secretary shall make a report 
                submitted under subparagraph (A) public.
            ``(5) Composition.--The Council shall be composed of--
                    ``(A) ex officio representatives from the Centers 
                for Disease Control and Prevention, the National 
                Institutes of Health, the United States Agency for 
                International Development, the Agency for Healthcare 
                Research and Quality, the Health Resources and Services 
                Administration, the United States-Mexico Border Health 
                Commission, and other Federal departments and agencies 
                that carry out significant activities related to 
                tuberculosis;
                    ``(B) State and local tuberculosis control and 
                public health officials;
                    ``(C) individuals who are scientists, physicians, 
                laboratorians, and other health professionals who 
                represent disciplines relevant to tuberculosis 
                elimination; and
                    ``(D) members of national and international 
                nongovernmental organizations established to address 
                the elimination of tuberculosis.''.
    (b) Rule of Construction Regarding Current Membership.--With 
respect to the advisory council under section 317E(f) of the Public 
Health Service Act, the amendments made by subsection (a) may not be 
construed as terminating the membership on such council of any 
individual serving as such a member as of the day before the date of 
the enactment of this Act.

           Subtitle C--New Tools for Tuberculosis Elimination

SEC. 121. NEW TOOLS.

    Section 317E of the Public Health Service Act (42 U.S.C. 247b-6) is 
amended--
            (1) by redesignating subsection (g) as subsection (h); and
            (2) by inserting after subsection (f) the following 
        subsection:
    ``(g) New Tools for Elimination of Tuberculosis.--
            ``(1) Research and development on drugs, diagnostics, 
        vaccines, and public health interventions.--The Secretary may 
        expand, intensify, and coordinate research and development and 
        related activities to develop new tools for the elimination of 
        tuberculosis, including drugs, diagnostics, vaccines, and 
        public health interventions, such as directly observed therapy 
        and non-pharmaceutical intervention, and methods to enhance 
        detection and response to outbreaks of tuberculosis, including 
        multidrug resistant tuberculosis. The Secretary shall give 
        priority to programmatically relevant research so that new 
        tools can be utilized in public health practice.
            ``(2) Federal tuberculosis task force.--
                    ``(A) Duties.--The Federal Tuberculosis Task Force 
                (in this subsection referred to as the `Task Force') 
                shall provide to the Secretary and other appropriate 
                Federal officials advice on the implementation of 
                paragraph (1), including advice regarding the efficient 
                utilization of the Federal resources involved.
                    ``(B) Comprehensive plan for new tools 
                development.--In carrying out paragraph (1), the Task 
                Force shall make recommendations on the development of 
                a comprehensive plan for the creation of new tools for 
                the elimination of tuberculosis, including drugs, 
                diagnostics, and vaccines.
                    ``(C) Consultation.--In developing the 
                comprehensive plan under paragraph (1), the Task Force 
                shall consult with external parties including 
                representatives from groups such as--
                            ``(i) scientists, physicians, 
                        laboratorians, and other health professionals 
                        who represent the specialties and disciplines 
                        relevant to the research under consideration;
                            ``(ii) members from public-private 
                        partnerships, private entities, or foundations 
                        (or both) engaged in activities relevant to 
                        research under consideration;
                            ``(iii) members of national and 
                        international nongovernmental organizations 
                        established to address tuberculosis 
                        elimination;
                            ``(iv) members from the general public who 
                        are knowledgeable with respect to tuberculosis 
                        including individuals who have or have had 
                        tuberculosis; and
                            ``(v) scientists, physicians, 
                        laboratorians, and other health professionals 
                        who reside in a foreign country with a 
                        substantial incidence or prevalence of 
                        tuberculosis, and who represent the specialties 
                        and disciplines relevant to the research under 
                        consideration.
            ``(3) Grants and contracts.--The Secretary may carry out 
        paragraph (1) directly and through awards of grants, 
        cooperative agreements, and contracts to public and private 
        entities, including--
                    ``(A) public-private partnerships;
                    ``(B) academic institutions, including institutions 
                of higher education;
                    ``(C) research institutions; and
                    ``(D) nonprofit entities established and dedicated 
                to tuberculosis vaccine and treatment product 
                development.''.

          Subtitle D--Evaluation of Public Health Authorities

SEC. 131. EVALUATION OF PUBLIC HEALTH AUTHORITIES.

    (a) In General.--Not later than 180 days after the date of 
enactment of the Comprehensive Tuberculosis Elimination Act of 2007, 
the Secretary of Health and Human Services shall prepare and submit to 
the appropriate committees of Congress a report that evaluates and 
provides recommendations on changes needed to Federal and State public 
health authorities to address current disease containment challenges 
such as isolation and quarantine.
    (b) Contents of Evaluation.--The report described in subsection (a) 
shall include--
            (1) an evaluation of the effectiveness of current policies 
        to detain patients with active tuberculosis;
            (2) an evaluation of whether Federal laws should be 
        strengthened to expressly address the movement of individuals 
        with active tuberculosis; and
            (3) specific legislative recommendations for changes to 
        Federal laws, if any.
    (c) Update of Quarantine Regulations.--Not later than 240 days 
after the date of enactment of this Act, the Secretary of Health and 
Human Services shall promulgate regulations to update the current 
interstate and foreign quarantine regulations found in parts 70 and 71 
of title 42, Code of Federal Regulations.

              Subtitle E--Authorization of Appropriations

SEC. 141. AUTHORIZATIONS OF APPROPRIATIONS.

    Section 317E of the Public Health Service Act, as amended by 
section 121(1) of this Act, is amended by striking subsection (h) and 
inserting the following:
    ``(h) Authorization of Appropriations.--
            ``(1) General program.--
                    ``(A) In general.--For the purpose of carrying out 
                this section, other than subsections (b) and (g), there 
                are authorized to be appropriated $300,000,000 for 
                fiscal year 2008, and such sums as may be necessary for 
                each of the fiscal years 2009 through 2012.
                    ``(B) Reservation for emergency grants.--Of the 
                amounts appropriated under subparagraph (A) for a 
                fiscal year, the Secretary may reserve not more than 25 
                percent for emergency grants under subsection (a) for 
                any geographic area, State, political subdivision of a 
                State, or other public entity in which there is, 
                relative to other areas, a substantial number of cases 
                of tuberculosis, multidrug resistant tuberculosis, or 
                extensively drug resistant tuberculosis or a 
                substantial rate of increase in such cases.
                    ``(C) Research, demonstration projects, education, 
                and training.--For the purpose of carrying out 
                subsection (b), there are authorized to be appropriated 
                such sums as may be necessary for each of fiscal years 
                2008 through 2012.
                    ``(D) Priority.--In allocating amounts appropriated 
                under subparagraph (A) and not reserved under 
                subparagraph (B), the Secretary shall give priority to 
                allocating such amounts for grants under subsection 
                (a).
                    ``(E) Allocation of funds.--
                            ``(i) Requirement of formula.--Of the 
                        amounts appropriated under subparagraph (A), 
                        not reserved under subparagraph (B), and 
                        allocated by the Secretary for grants under 
                        subsection (a), the Secretary shall distribute 
                        a portion of such amounts to grantees under 
                        subsection (a) on the basis of a formula.
                            ``(ii) Relevant factors.--The formula 
                        developed by the Secretary under clause (i) 
                        shall take into account the level of 
                        tuberculosis morbidity and case complexity in 
                        the respective geographic area and may consider 
                        other factors relevant to tuberculosis in such 
                        area.
                            ``(iii) No change to formula required.--
                        This subparagraph does not require the 
                        Secretary to modify the formula that was used 
                        by the Secretary to distribute funds to 
                        grantees under subsection (a) for fiscal year 
                        2007.
            ``(2) New tools.--
                    ``(A) In general.--For the purpose of carrying out 
                subsection (g), there are authorized to be appropriated 
                $100,000,000 for fiscal year 2008, and such sums as may 
                be necessary for each of the fiscal years 2009 through 
                2012.
                    ``(B) Limitation.--The authorization of 
                appropriations established in subparagraph (A) for a 
                fiscal year is effective only if the amount 
                appropriated under paragraph (1) for such year equals 
                or exceeds the amount appropriated to carry out this 
                section for fiscal year 2007.''.

                TITLE II--NATIONAL INSTITUTES OF HEALTH

SEC. 201. RESEARCH AND DEVELOPMENT CONCERNING TUBERCULOSIS.

    Subpart 2 of part C of title IV of the Public Health Service Act 
(42 U.S.C. 285b et seq.) is amended by inserting after section 424B the 
following section:

``SEC. 424C. TUBERCULOSIS.

    ``(a) In General.--The Director of the National Institutes of 
Health may expand, intensify, and coordinate research and development 
and related activities of the Institute with respect to tuberculosis 
including activities toward the goal of eliminating such disease.
    ``(b) Certain Activities.--Activities under subsection (a) may 
include--
            ``(1) enhancing basic and clinical research on 
        tuberculosis, including drug resistant tuberculosis; and
            ``(2) expanding research on the relationship between such 
        disease and the human immunodeficiency virus.''.
                                                       Calendar No. 549

110th CONGRESS

  1st Session

                                S. 1551

_______________________________________________________________________

                                 A BILL

To amend the Public Health Service Act with respect to making progress 
  toward the goal of eliminating tuberculosis, and for other purposes.

_______________________________________________________________________

                           December 18, 2007

                       Reported with an amendment